Supported by PHS Grants 526-02 and 60-30, we have developed an automated, centralized clinical laboratory which performs large volumes of various tests, rapidly, reliably and economically for 2 units (5 mi. apart) of our 1000 bed hospital. A laboratory computer controls Data Acquisition and Information Systems and performs all calculations. Daily cumulative reports for physicians are printed by the hospital computer using the patient's data base. We have evaluated the impact of these techniques on cost benefits, technologist productivity, space and equipment needs and centralization. Supported by PHS Grant 60-04Al, we are installing DIVOTS (Data Input Voice Output Telephone System) whereby Touch-Tone Card Dialer phones on Wards and doctors' offices communicated directly to a computer which initiates on line test order entry and confirms test data by audio-response. Test results in the computer are transmitted by voice to physicians by DIVOTS. The economic, operation, quality control and professional advantages are being evaluated by a System Engineer and Industrial Engineer and Industrial Engineer consultants from Youngstown State University. We believe that DIVOTS should be expanded to include other important sectors of the Health Care System to increase the productivity of the physician to improve quality of patient care. We wish to study its application in the pharmacy and clinical pharmacology. The system will permit automatic drug ordering, prescription preparation and verification, printing labels and records, create audit trial for control and lead to substantial labor savings, improved reliability and safeguards against error. More importantly, we wish to study the interaction of drugs on laboratory tests, interactions between drugs to determine toxic or excessive dosage, the detect abuses in prescribing practices, to forecast possible toxic reactions and to bring the clinical pharmacologist into the Health Care System. Assessment of cost/benefits, proficiency and equivalency of manpower and quality criteria will be continued for scope and effectiveness of institutional and ambulatory care patients. "The undersigned agrees to accept responsibility for the scientific and technical conduct of the project and for provision of requireed progress reports if a grant is awarded as the result of this application".